Gland or duct diagnostic and treatment methods and related apparatus

ABSTRACT

A method is provided for treating a gland or duct of a patient. In a particular embodiment, an obstruction in a gland or duct and the orifice thereof can be alleviated; in another, a substance can be injected thereinto; in yet another, the gland can be aspirated. The method includes the step of inserting an elongated probe into a gland or duct via an orifice thereinto. In some embodiments the probe can have a longitudinal lumen therethrough, with at least one distal hole through the probe wall in fluid communication with the lumen. The lumen can be used in concert with a source of suction for removing debris from the gland or duct, and/or with a source of a fluid and pumping means, for injecting a substance into the gland or duct.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. Non-provisional applicationSer. No. 12/643,333, filed on Dec. 21, 2009, which is acontinuation-in-part of U.S. Non-provisional application Ser. No.12/305,094, filed on Dec. 16, 2008, which was the §371 National Stage ofInternational Application No. PCT/US08/083318, filed on Nov. 13, 2008,which claims the benefit of U.S. Provisional Application Ser. No.60/987,521, filed on Nov. 13, 2007, the contents of which applicationsare hereby incorporated by reference in their entirety.

FIELD OF THE INVENTION

The present invention relates to systems, devices, and methods fortreating and diagnosing ailments of glands and ducts, and particularlyto removing obstructions or other types of material from, and addingmaterial such as medication into, glands and ducts.

BACKGROUND OF THE INVENTION

There are thousands of different glands and ducts in the human body,producing a wide variety of secretions. Problems with individual glandsor ducts can result in conditions that are irritating, at best, and canpresent potentially serious health issues. Because of the small size ofmost glands and ducts, diagnosing and treating problems with individualsglands or ducts can be difficult or impossible with current technologyand therapeutic methods.

To give one example, “dry eye syndrome” can be caused by, among otherthings, obstructions in the meibomian gland, preventing lipid secretionsfrom reaching the surface of the eye. These lipid secretions, in ahealthy eye, form the outer layer of the tear film, and thereby assistin reducing tear evaporation during waking hours.

Currently, dry eye syndrome is treated, depending upon the severity,with over-the-counter preserved tears, topical and systemic medications,and even surgery. The patient's environment, dietary habits, andmedications are considered and can be addressed if thought to be afactor in producing patient's dry eye syndrome.

However, at present there is no effective way of removing obstructionswithin the meibomian gland, and therefore it would be desirable toprovide a system, device, and method for doing so. Similarly, otherglands and ducts, both ophthalmic and non-ophthalmic could benefit fromsuch systems, devices and methods.

SUMMARY OF THE INVENTION

The present invention is directed to a system, device, and method fortreating an individual gland or duct of a patient. In a particularaspect, an obstruction in a gland or duct and the orifice thereof can bealleviated; in another, a substance can be injected thereinto; in yetanother, the gland or duct can be aspirated.

The method comprises inserting an elongated probe into a gland or ductvia an orifice thereinto. In some aspects the probe can have alongitudinal lumen therethrough, with at least one distal hole through aprobe wall in fluid communication with the lumen. The lumen can be usedin concert with a source of suction for removing debris from the glandor duct, and/or with a source of a fluid and pumping means, forinjecting a substance into the gland or duct.

The features that characterize the invention, both as to organizationand method of operation, together with further objects and advantagesthereof, will be better understood from the following description usedin conjunction with the accompanying drawing. It is to be expresslyunderstood that the drawing is for the purpose of illustration anddescription and is not intended as a definition of the limits of theinvention. These and other objects attained, and advantages offered, bythe present invention will become more fully apparent as the descriptionthat now follows is read in conjunction with the accompanying drawing.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side perspective view of a probe being inserted into ameibomian gland of an eyelid of a patient.

FIG. 2 is a side perspective view of a probe having apertures into alumen.

FIGS. 3 and 4 are cross-sectional views of the probe of FIG. 2 alonglines 3-3 and 4-4, respectively.

FIG. 5 is a side cross-sectional view of an eyelid, including ameibomian gland.

FIG. 6 is a side cross-sectional view of a meibomian gland and adetailed view of an acinar complex.

FIG. 7 is a cross-sectional view of an obstructed meibomian gland.

FIGS. 8 and 9 are side cross-sectional views of a meibomian gland with aprobe inserted thereinto and injecting a pharmacological agent (FIG. 8)and performing aspiration (FIG. 9).

FIG. 10 is a side perspective view of an instrument for supporting aprobe.

FIG. 11 is a side perspective view of an automated instrument forsupporting and guiding a probe with a pump for aspiration and/ordelivery.

FIG. 12 is a side cross-sectional view of a probe having a double lumenfor performing both aspiration and fluid delivery.

FIG. 13 is a side cross-sectional view of a probe having a movableelement therein.

FIGS. 14-18 are side cross-sectional views of alternate embodiments ofprobe tips.

FIGS. 19 and 20 are side cross-sectional views of a meibomian glandillustrating the use of an exfoliating probe.

FIGS. 21 and 22 are side cross-sectional views of a meibomian glandillustrating the use of a heating element.

FIGS. 23 and 24 are side cross-sectional views of a meibomian glandillustrating the use of a “scoop”-type probe.

FIGS. 25 and 26 are side cross-sectional views of a meibomian glandillustrating the placement of a delivery element therein.

FIGS. 27 and 28 are side cross-sectional views of a meibomian glandillustrating the use of a stent-delivery probe.

FIG. 29 is a side cross-sectional view of a probe having a double lumenand a movable element in one of the lumina.

FIG. 30 is a schematic side view of a probe having a distal endconnected with a bent cannula.

FIG. 31 is a partial schematic side view of a probe having distal endadvanceable in fixed intervals, with hidden components shown in brokenlines.

FIG. 32 is a schematic side view of a probe having a spool of wireadvanceable to replace a damaged distal end and a plunger to advance thedistal end, with hidden components shown in broken lines.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

A description of the preferred embodiments of the present invention willnow be presented with reference to FIGS. 1-32.

The system, device, and method for treating a gland or duct of an eyelidof a patient can include the use of a probe to perform a plurality ofprocedures, such as, but not intended to be limited to, alleviating anobstruction therein. For illustrative and exemplary purposes, thefollowing embodiments are described in the context of treatment of ameibomian gland. However, the present invention contemplates thetreatment of any bodily gland or duct. For example, other ophthalmicglands or ducts that can be treated include lacrimal glands andassociated secretory ducts, accessory lacrimal glands of Krause andWolfring, and sebaceous glands of Zeis. Examples of non-ophthalmicglands or ducts that can advantageously be treated pursuant to thepresent invention include skin-related sebaceous and sweat glands.

The present inventor has found that the meibomian gland can besuccessfully penetrated with such a probe, to clear obstructions or forother treatments, with a sufficiently thin probe. Accordingly, allembodiments entail the use of an elongated probe having a distal portiondimensioned for insertion into a meibomian gland via an orifice thereof.An exemplary probe 10 (FIG. 1) has a tip or distal end 11 dimensionedfor insertion into an orifice 12 of a meibomian gland 13 (FIGS. 5-7). Inbasic embodiment, the distal end 11 is a thin wire fixedly secured, forinstance with epoxy, to the remainder of the probe 10. The distal end 11can be formed from stainless steel or another bio-suitable material. Theprobe 10 can be made to be autoclavable and re-usable, or disposable forone-time use.

The meibomian gland 13 is a modified sebaceous gland surrounded by densecollagen that produces oil droplets, waxes, and cholesterol 14 thatmigrate from evaginations 15 in the gland's interior space 16 toward theorifice 12 at the eyelid margin 17. The lipid secretions produced serveto stabilize tears, and there are typically approximately 24 such glandsper human eyelid. An obstructed orifice 12′ is illustrated in FIG. 7.

A typical gland orifice 12 has a diameter of approximately 0.1 mm. Thus,the probe 10 advantageously has distal end with an outer diameter ofapproximately 100 μm or less, and most advantageously approximately 50μm to approximately 80 μm. Alternately, probes with a larger outerdiameter, of between approximately 100 μm and approximately 150 μm,particularly for glands or ducts with larger orifices, but also formeibomian glands. Additionally, a typical, non-atrophied gland 13 has adepth, from the orifice 12 to a distal end 19, of approximately 4 mm toapproximately 6 mm. Generally, the lower lid has shorter, wider glandsthan the upper lid. Thus, the probe 10 advantageously has a distal endwith a length of 6 mm or less. Distal ends 11 with lengths ofapproximately 1 mm, approximately 2 mm and approximately 4 mm are alsoadvantageous.

Where a wider distal end is to be inserted, for example having an outerdiameter closer to 100 μm, it has been found advantageous to previouslyinsert one or more narrower distal ends, for example, 50 μm and/or 80 μmto initially clear any blockage within the orifice 12 and to relax theorifice to ease entry of the larger distal end(s). Depending on theparticular circumstances, for instance the time constraints or paintolerance of the patient, a week or more can elapse between insertion ofthe narrower and wider distal ends.

Where a longer distal end is to be inserted, for example having a lengthof approximately 4 mm to 6 mm, it has been found advantageous topreviously insert one or more shorter distal ends, for example, 1 mm or2 mm to initially clear any blockage within the orifice 12. For distalends of equal diameter, the shorter distal ends will generally exhibit agreater resistance to bending than the longer distal ends. Thus, thelikelihood of successful insertion of longer distal ends into themeibomian glands can be enhanced with prior insertion of one or moreshorter distal ends.

In practice with a probe 10, the present inventor has discoveredevidence of the formation of both fibrotic bands and vascular structureswith the meibomian gland central duct. The presence of fibrotic bandswithin the meibomian gland duct can be indicated by initial resistanceto the insertion of the probe 10 that is overcome following a “pop” uponbreaking through the bands. The presence of vascular structures can beindicated by the presence of a drop of blood after removing the probe10. The routine existence of such structures within the meibomian glandduct was, to knowledge of the present inventor, previously unknown.Based on this discovery, the present invention further extends totherapeutic modalities to prevent the re-formation of such structures.Thus, treatment can be further directed at remedying the conditionunderlying the improper or reduced function of the meibomian gland,rather than simply clearing obstructions as they form. For instance,medicines including fibrous tissue and/or vascular tissue growthinhibiting agents, such as steroids and/or vascular endothelial growthfactor (VEGF) inhibitors, can be introduced into the meibomian gland.

Subsequent to the present invention, penetration of the meibomian glandto clear obstructions has been accomplished using an instrument havingan energized tip. Using plasma energy, the device effectively vaporizesobstructions, as well as any other matter, including living tissue, thatcomes into contact with the energized tip. Significantly, the probe 10and related methods of use do not require the application of thermalenergy, electromagnetic energy or other radiation, or other energybeyond the application of mechanical force sufficient to physicallypenetrate the meibomian gland. However, the present invention is notnecessarily limited to purely physical penetration. Additionally, thepresent invention can advantageously include the application ofadditional energy after the probe 10 has been inserted through theorifice 12.

In addition to reducing the risk of trauma to otherwise healthy tissue,the penetration of the meibomian gland without the application ofthermal or electromagnetic energy to the probe 10 facilitates thediagnosis of the potential underlying conditions described above. Forinstance, plasma energy would readily vaporize fibrotic bands, notallowing the surgeon to feel the indicative resistance and subsequentpop. Similarly, vascular structures would also be vaporized, andcapillaries feeding the structures would likely be immediatelycauterized, eliminating the blood evidence.

In another embodiment (FIG. 30), a probe 110, a distal end 111 isattached to the probe 110 by a bent cannula 112. The bent cannula 112serves to move most of the body of the probe 110 out of the line ofsight of a doctor when inserting the distal end 111 in the meibomiangland. Advantageously, the cannula is bent to an angle 113 ofapproximately 30 degrees.

In a further embodiment (FIG. 31), a probe 210 has a distal end 211 thatis displaceable relative to a body 212 of the probe 210. The distal end211 is connected to an operator 213 and slidably supported in a channel214 defined within a distal section 215 of the body 212. Using theoperator 213, the distal end 211 is advanceable and retractable.Preferably, the detents 216 are formed in the body 212 to allow thedistal end 211 to be advanced and retracted in fixed intervals 217.Advantageously, three detents 216 are formed with intervals 217therebetween of approximately 2 mm, allowing the distal end 211 to beadvanced to a maximum length 218 of approximately 6 mm. Preferably, thechannel 214 supporting the distal end 211 has a length 219 at leastequal to the maximum length 218. It will be appreciated that the probe210 reduces the need for separate probes having differently dimensioneddistal ends.

In an additional embodiment (FIG. 32), a probe 310 has a distal end 311connected to a wire spool 312. Within a probe body 313, wire from thespool 312 is routed through a fixation element 314, which is rearwardlybiased against a plunger 315 by a spring 316. The spring 316 is arrangedin a cap 317 that is releasably connected, for instance by a threadedjoint, to the body 313, allowing easier access to the wire.

The distal end 311 is threaded through the fixation element 314 to theend of the cap 317 by feeding wire from the spool 312. A thumb wheel orother operation may advantageously be provided for the spool 312. Thefed wire is secured within the fixation element 314. The plunger 315 isthen operable to engage the fixation element 314 to advance the distalend 311 to a desired length. Preferably, the plunger 315 is operable incooperation with the body 313 to advance the distal end 311 in fixedintervals. It will be appreciated that the probe 310 reduces the need todispose of a probe when its distal end becomes bent or otherwiserendered unsuitable for continued use. Instead, the unsuitable portioncan be cut off and the wire advanced to form a new distal end.

In the embodiment illustrated in FIGS. 2-4, 8, and 9, the probe 20 canhave a longitudinal lumen 21 therethrough, with a plurality of distalholes 22 through the probe wall 23 in fluid communication with the lumen21, as well as a tapered tip 24. The lumen 21 can be used in concertwith a source of suction 25 (FIG. 9) for removing contents 26 from themeibomian gland 13, and/or with a source of a fluid and pumping means 27(FIG. 8), for injecting a substance 28 into the meibomian gland 13. Forprobes having longitudinal lumens, polyimid tubes have been foundsatisfactory.

In order to provide stability to the probe 10, an apparatus may becontemplated for supporting the probe 10. For example, in the apparatus30 illustrated in FIG. 10, an articulated arm 31 is affixed to a base32, the arm 31 having a clamp 33 at a distal end 37 for releasablyholding the probe 10. A patient head rest 34 retains the eye 35 in astable position, and the physician can visualize the eyelid 36 and probe10 through visualization optics, for example, a scope 36, which arepositioned on an opposite side of the probe 10 from the patient eyelid35.

In another apparatus 40 illustrated in FIG. 11, a motion-producingelement such as a motor 41 driven automated support 42 is affixed to abase 43, and is controllable by a user. The motion imparted to the probe10 is preferably substantially linear, and, once the user hasascertained that the probe tip 11 is aligned with the gland orifice 12,the motor 41 can be activated to impel the probe 10 into the meibomiangland 13. The other elements can be substantially the same as in FIG.10.

Visualization can also be enhanced with the use of cross-illumination onthe lower lid, for either manual insertion of the probe 10 or insertionusing the apparatus 30 or 40. Cross-illumination of the lower lid canalso aid in determining whether a given meibomian gland has atrophied,such there is, effectively, no gland to penetrate.

In another embodiment, a probe 50 (FIG. 12) includes a double lumen51,52 running axially therealong. The first lumen 51 can be used foraspiration through a first distal hole 53 in fluid communicationtherewith, while the second lumen 52 can be used for injection of afluid through a second distal hole 54 in fluid communication therewith.

A further embodiment 60 (FIG. 13) includes an elongated element 61movable within the probe lumen 62 a distal section 56 of which isadapted to protrude out from the probe's distal end 55. The movableelement 61 can have an enlarged tip 63 to assist in removingobstructions, which can protrude out from the probe distal end 55. In asimilar embodiment, a probe 65 (FIG. 29) having a double lumen 66,67 canhave a movable element 68 in one of the lumina 66, with the second lumen67 having apertures 69 in communication therewith.

It may be contemplated by one of skill in the art that a plurality ofprobe tip embodiments may be encompassed by the present invention. Theprobe tip embodiments can comprise an obstruction-removing elementuseful for, for example, dislodging debris from the meibomian gland whenthe probe is moved therewithin.

The probe tip embodiments can include, but are not intended to belimited to, an exfoliating tip 70 (FIG. 14), a tip 71 having a heatingelement 72 (FIG. 15), a tip 73 having a router 74 articulated at adistal end 81 (FIG. 16), a tip 75 having a gripper 76 for holding areleasing a medication-delivery element such as a pill 77 (FIG. 17), anda tip 78 having a gripper 79 for delivering a compressible,substantially toroidal stent 80 (FIG. 18). The stent may have drugeluting properties to deliver a pharmaceutical or other liquid therapyover time. In connection with some or all of these tips, particularly,the exfoliating and routing tips, a means for imparting vibratory motioncan be coupled with the tip. Vibration at ultrasonic frequencies canalso be employed.

The uses of these tips are illustrated in FIGS. 19-28. In FIGS. 19 and20, the exfoliating tip 70 is shown loosening material from the glandwall 18; in FIGS. 21 and 22, the heating element 72 is used to releasecontents by reducing fluid viscosity; in FIGS. 23 and 24, the router 74is expanded to scrape debris out the orifice 12; in FIGS. 25 and 26, thegripper tip 76 is used to deliver a pill 77 to the gland wall 18, whichcan contain such materials as, but not intended to be limited to,medication, stem cells, solvents, growth factors, nutrients, vitamins,hormones, genetic vectors, a nanotechnological element, or a radioactivesubstance for treating sebaceous cell or other type of cancer. In FIGS.27 and 28, the stent-delivery tip 79 is illustrating as holding thestent 80 in a compressed condition and leaving in place the stent 80,which will expand for assisting in keeping the orifice 12 in an openposition. Although, the depicted stent 80 is substantially confined tothe orifice 12, the present invention can also include stents thatextend from the orifice into the gland or duct for all, or a portion of,its length. Stents located within the duct or gland but not extending into the orifice can also be used.

It can be seen that the various embodiments of probes disclosed hereinare useful for a plurality of purposes, including those outlined aboveand diagnostic cytology, brachytherapy, and light-activated fluorescencefor treating cancer.

In the foregoing description, certain terms have been used for brevity,clarity, and understanding, but no unnecessary limitations are to beimplied therefrom beyond the requirements of the prior art, because suchwords are used for description purposes herein and are intended to bebroadly construed. Moreover, the embodiments of the apparatus and methodillustrated and described herein are by way of example, and the scope ofthe invention is not limited to the exact details of construction oruse.

Having now described the invention, the construction, the operation anduse of preferred embodiments thereof, and the advantageous new anduseful results obtained thereby, the new and useful constructions, andreasonable mechanical equivalents thereof obvious to those skilled inthe art, are set forth in the appended claims.

What is claimed is:
 1. A device for treating a gland or duct of apatient comprising: a probe having an elongated distal end with an outerdiameter of approximately 150 μm or less and a length of approximately 6mm or less.
 2. The device recited in claim 1, wherein the probe has alongitudinal lumen extending therealong defined by a probe wall and adistal hole through the probe wall in fluid communication with thelumen, the distal hole positioned in the probe distal end.
 3. The devicerecited in claim 2, further comprising a pump element in fluidcommunication with the lumen for pumping fluid through the lumen and outthe distal hole into the meibomian gland.
 4. The device recited in claim2, wherein the distal hole comprises a plurality of distal holes.
 5. Thedevice recited in claim 2, wherein the probe lumen comprises a firstlumen and a second lumen, and the distal hole comprises a first distalhole in fluid communication with the first lumen and a second distalhole in fluid communication with the second lumen, such that suction canapplied to the first lumen while fluid is injected through the secondlumen.
 6. The device recited in claim 2, further comprising an elongatedelement positioned at least partially within the probe lumen and movablerelative thereto to protrude from the probe distal end.
 7. The devicerecited in claim 6, wherein the elongated element comprises a distal tiphaving a diameter greater than a diameter proximal thereof for assistingin obstruction removal.
 8. The device recited in claim 6, wherein theprobe lumen comprises a first lumen and a second lumen, the distal holecomprises a first distal hole in fluid communication with the firstlumen and a second distal hole in fluid communication with the secondlumen, and the elongated element is positioned within the first lumen.9. The device recited in claim 2, further comprising a structuralsupport positionable by the device within the gland or duct adjacent anatural orifice thereinto, for assisting the retaining the orifice in anunobstructed condition.
 10. The device recited in claim 9, wherein thestructural support comprises a compressible, substantially toroidalelement, and the elongated element comprises a gripper operable adaptedfor releasably holding the toroidal element in a compressed condition, arelease of the toroidal element from the gripper permitting the toroidalelement to expand and assist in holding the orifice open.
 11. The devicerecited in claim 1, wherein the probe has an obstruction-removingelement adjacent the probe distal end adapted for dislodging debris fromthe gland or duct.
 12. The device recited in claim 11, wherein theobstruction-removing element comprises a heating element.
 13. The devicerecited in claim 11, wherein the obstruction-removing element comprisesan abrasive surface on the probe distal end for exfoliating the gland orduct.
 14. The device recited in claim 11, wherein theobstruction-removing element comprises a router articulated at a distalend, such that, upon inserting the probe distal end, the router is ableto be opened and moved in a proximal direction for scraping the gland orduct.